When medical insurance eligibility claims are submitted, it is typically performed through computer based systems using electronic insurance eligibility transactions. Common industry terminology of one form of these transactions is a 270/271 transaction. Electronic insurance eligibility transactions, such as the 270 insurance eligibility transaction requests and the 271 insurance eligibility transaction responses, typically take place between a hospital/physician (healthcare provider) and a payor (insurance provider) to determine whether a patient has healthcare insurance coverage and benefits, such as co-pay, co-insurance, and/or deductibles. Quite often, insurance eligibility transaction responses return “member not found” (no information found for the person for which the insurance eligibility transaction request was made), or inaccurate data likely due to the wrong patient being identified for insurance coverage.
Despite the advances in the field, the industry is in need of more efficient systems and methods for enhancing and authenticating insurance eligibility transactions.